safety and efficacy of oral cannabis in chronic spine pain

Conditions: Back Pain; Neck Pain

Summary: the overall objectives of this study are to investigate the efficacy of extended cannabis treatment to reduce patient exposure to prescription opioids through its use 1) as a non-opioid analgesic treatment, and 2) as a therapy for reducing high-dose opioid use in patients with chronic spine pain.

this randomized, placebo-controlled clinical trial is designed to elucidate the role of extended oral cannabis treatment in the alleviation of chronic spine pain and reduction of high-dose opioid use. this trial includes two study arms: analgesia arm and reduction arm. the analgesia arm uses a within-subject crossover design to determine whether daily treatment with an oral cannabis solution for 6 weeks significantly reduces spine pain compared to placebo. the reduction arm uses a parallel design to determine whether daily treatment with an oral cannabis solution for 13 weeks results in a greater reduction of pain and opioid intake than placebo treatment. it will also assess the impact of extended cannabis treatment on opioid craving and symptoms of opioid withdrawal in participants tapering their high-dose opioids.

Eligibility criteria:
some inclusion/exclusion criteria are purposely omitted at this time to preserve scientific integrity. they will be included after the trial is complete. inclusion criteria: documented chronic (≥3 months' duration), non-radicular spine pain exclusion criteria: unwilling/unable to refrain from cannabis use (medical or recreational) for 14 days prior to baseline visit and throughout the study (other than study drug). this includes whole plant inhalation, edibles, extracts, and topicals. co-morbid cancer-related pain condition neuropathic pain a co-morbid pain condition that is of greater severity than the patient's spine pain spine or other major surgery within the 3 months prior to enrollment planned surgery or procedural intervention during the study period allergy or adverse reaction to cannabis current or historical substance use disorder current or historical alcohol use disorder current or prior cannabis abuse/dependence positive result for use of amphetamine/methamphetamine, barbiturates, benzodiazepines, cocaine, phencyclidine (pcp), ecstasy (mdma), as detected on urine screen current use of valproate, clobazam, clopidogrel, warfarin, barbiturates, benzodiazepines prior adverse reaction to cannabis exposure (paranoia, anxiety, etc.) history or diagnosis of schizophrenia, bipolar or a psychotic disorder history of any mental health illness that in the opinion of the investigator would compromise the safety of the participant current or historical severe depression current suicidal ideation diagnosed cognitive impairment (e.g. alzheimer's disease, traumatic brain injury) uncontrolled hypertension (\>139/89) abnormal values on cbc (complete blood count) or cmp (comprehensive metabolic panel) laboratory analysis that are deemed clinically significant by study physician known hepatic disease or dysfunction, or identification of such on screening laboratory studies known cardiovascular disease abnormal result on electrocardiogram (ecg) that is deemed clinically significant by study md cognitive disability that interferes with ability to provide consent or understand study procedure history of seizure disorder diagnosed autoimmune or rheumatological disease such as rheumatoid arthritis (ra) or multiple sclerosis (ms) inability to refrain from using tobacco for at least 4 hours presence of a condition or abnormality that in the opinion of the investigator would compromise the safety of the participant or the quality of the data pending legal action or workers compensation pregnant females or females intending to become pregnant during the study period unwilling to use one of the accepted forms of contraception during the study period and for at least 60 days after completion of the study (females of childbearing potential and males with sexual partners of childbearing potential) lactating females analgesia arm exclusion criteria: unwilling/unable to discontinue current opioid use for 14 days prior to baseline study visit and throughout the study reduction arm exclusion criteria: not interested in reducing or discontinuing use of prescribed opioids for chronic pain unwilling to allow the study team to communicate with the participant's opioid prescribing provider \*some inclusion/exclusion criteria are purposely omitted at this time to preserve scientific integrity. they will be included after the trial is complete.